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June 3, 2021 Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service.
The... August 12, 2020 By Sandra Gauron, Audit and Appeals Coordinator
In an effort to provide Administrative Law Judge (ALJ) backlog relief, CMS launched the Settlement Conference Facilitation (SCF) pilot program in July 2014. SCF is an alternative dispute resolution... June 29, 2020 CMS has updated the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131). Providers can use the new form now, and mandatory use of the form will be on 8/31/2020. The form is valid through 06/30/2023. On or after 8/31/2020, issuing an ABN... February 25, 2020 The van Halem Group will be partnering with Össur Americas, Inc., a global manufacturer of orthotic and prosthetic products. As part of this agreement, The van Halem Group will provide clinical prescreen reviews and appeal services for custom orthotics... February 6, 2020 CMS has approved two new topics for the DMEPOS RAC, Performant, to begin reviewing, effective March 1, 2020.
Hospital Beds: Medical Necessity and Documentation Requirements
Description: Hospital Beds must meet basic coverage criteria whether at... January 28, 2020 By Abrielle Uritz, RN, BSN, CPC, CEMC
As a Doctor of Chiropractic, responding to a medical records request can be challenging; however, the A and B MACs have created a tool that will help to adequately respond to these requests. This includes guidance... January 23, 2020 By Kim Turner, RN
No matter how careful, Medicare claim mistakes
will happen. When they do, your claim may not be able to be processed by the
DME MAC. Listed below are some common errors which prevent your claim from
being processed. If you find a... January 6, 2020 In the SMRC's (Supplemental Medical Review Contractor) most recent current project detail for Diabetic Test Strips, they include verbiage that not only impacts the DME supplier, but also the ordering practitioner.
Specifically the SMRC's current... December 26, 2019 Effective January 1, 2020, Performant will begin reviewing Surgical Dressings and Cervical Orthoses. Details are provided below.
Surgical Dressings: Medical Necessity and Documentation Requirements
Description: This review will determine... December 16, 2019 By Kim Turner, RN, Clinical Consultant
Key points from the CMS CR 11570
New DMEPOS HCPCS codes have been added to the HCPCS file effective January 1, 2020. Suppliers can start using the new codes for billing effective on January 1, 2020. There...